While there are many external pressures associated with the reform agenda, I contend that the most essential change is needed within. It is about fostering leadership at the centre and nurturing the basic humanity of residential aged care communities.
Here I aim to add to the discussion in the article Leading change – published in the September-October edition of Australian Ageing Agenda – which highlighted the need for leadership in response to the wave of reforms challenging the aged care sector, prompted by the royal commission in its 2021 final report Care, Dignity, and Respect.
Some of the themes discussed in that article include leadership, strengthening workplace culture, and the significance of psychological safety.
My PhD research into person-centredness and leadership in aged care, completed last year, revealed the crucial importance of putting your people at the centre. It’s about fostering a person-centred environment that embraces everyone in the aged care home, including residents, families, staff, and managers.
Such person-centredness builds a robust culture expressed in positive human connections, interactions and relationships. While person-centredness, with its strengthening of the organisation’s core, provides inherent internal benefits, it also has the potential to embrace and enhance the aged care reforms, especially at the aged care home level.
It provides firmer ground and potentially works to maximise and support the reforms and their intent. Having person-centredness as the priority also helps to ensure that we aren’t lost or distracted in the turmoil of the change process and that the focus stays with people.
Person-centred leadership
Person-centredness is empowering for all. Residents are respected and treated as people, not numbers on a checklist. Their needs, wants, and preferences are understood and valued, and they have a sense of belonging. They have a say over their lives in the residential community.
Such person-centredness provides the context for the exercise of leadership. Person-centredness for staff is the great equaliser because it means that staff and managers at all levels have a joint mission, a prime directive. Person-centredness is an unambiguous organisational priority.
While particular managers might be given the job of driving structural or policy changes, leadership can move among members of an organisation. Depending on the circumstances, anyone can lead. Leadership is not the property of individuals, but it can emerge according to the situation or context.
In my research, I found that leadership can come from within and be dispersed amongst staff, who are empowered in and by their responses to the needs of residents. They have a shared responsibility due to the importance of person-centredness. It is the power of the culture.
Once person-centredness is established, leadership becomes more a function of the collective rather than left to individuals. While it may need to be kick-started by designated leaders or managers – perhaps as part of a change process – once person-centredness is embedded in the culture, it can be increasingly self-perpetuating.
In this sense, leadership can be regarded as a function or process involving influence or direction. It can include anyone, not just people in management positions. Managers may not necessarily be leaders.
Person-centredness and workforce wellness
Person-centredness as experienced by staff has many benefits. As such, it contributes to staff wellbeing and is integrally connected to workforce wellness and organisational health. I see workforce wellness as a multidimensional concept relating to the optimal health of the whole person – mind, body and soul – in the context of the work environment.
Achieving workforce wellness is an ongoing process at individual, workplace and organisational levels. It is mutually reinforcing and it applies to all functions and roles. It is reflected in self-care, also known as work-life balance, reciprocal care, and collective care.
An indicator of workforce wellness is that staff can perform at their best with heart and soul, and with a sense of personal fulfilment, thriving, and belonging. They have a sense of purpose and meaning in their work, in harmony with personal values and ethics. They have a vital sense of achievement in knowing they contribute something positive to people’s lives.
In my research into staff’s lived experience in the person-centred aged care environment, staff feel empowered and stronger. For example, when staff walk in the door at the start of the day, they have a positive feeling; they don’t feel fearful or afraid.
Another way of looking at it is staff can bring their whole selves to work. This means they are not holding back a part of themselves; they feel psychological safety. They feel free to speak up and express their views because they feel supported.
This also means that they are alive to creative possibilities, especially concerning problem-solving and meeting residents’ challenging needs. In other words, staff have agency, directly affecting their response to residents.
While person-centred organisations accentuate the positive, they also promote workforce wellness by working to remove negative factors, especially concerning poor staff dynamics. For example, they have no tolerance for workplace bullying and harassment. They want their staff to live their best life when at work.
Workforce wellness, fostered by the person-centred environment, has various characteristics and indicators. Some of these include:
- staff are happy, healthy, positive, engaged and resilient
- staff are responded to and treated in a human, respectful way
- staff feel supported, respected, known, safe, valued, included, trusted, informed and heard
- positive connections and relationships with all
- maximised organisational performance, teamwork and individual engagement.
The person-centred environment
I found in my research that person-centred organisations are like ecosystems; there is an energy flow. An emotion felt in one part of the system, for example with staff, can have parallel effects on other parts of the system, such as with residents, and vice versa. Some other specific aspects are:
- you can see the person-centred culture in how people interact, for example, friendliness, comfortable familiarity, and openness
- you can feel its energy – there’s a positive vibe, sense of warmth and welcoming sense of community
- an empowering, non-hierarchical inclusiveness with a sense of working together and staff having a say
- management approachability, for example, being welcomed into their space
- empathetic, responsive, person-centred and relational leadership, and a leadership exercised at all levels
- reflection in the culture – it is part of the culture and “how we work here.”
Take home message
In residential aged care, it is critical to foster a person-centred environment where everyone is treated in a respectful, person-centred way, without exceptions.
Person-centredness needs to be an unequivocal organisational priority – the prime directive for staff and managers at all levels. At their heart, such organisations are about people; they celebrate the richness of human encounters.
Dr Sean Mack has a PhD in leadership and person-centred care from Charles Sturt University and his own business, Core Directions Consulting
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